Hypoglycemia Facts

Signs of Hypoglycemia

Low blood sugar is most common in people who use insulin or take certain tablets to reduce high blood sugar. This is because things like unplanned physical activity, eating meals later than usual, or drinking too much alcohol can mean that you need less insulin than you thought, causing your blood sugar to drop very low.

Signs that your blood sugar is too low may include:

Racing pulse

Cold sweat

Pale face

Headache

Feeling incredibly hungry

Shivering, feeling weak in the knees

Feeling restless, nervous or anxious

Difficulty concentrating, confusion

These symptoms do not occur all at once. The signs of hypoglycemia not only depend on the blood sugar level, but also vary from person to person. If you are not sure whether your blood sugar is too low, you can measure it to make sure. Mild hypoglycemia does not usually have any harmful effects. But it is important to react quickly enough and eat or drink something, such as dextrose sugar or sugary drink.

People who have severe hypoglycemia may feel very drowsy and confused, and might even become unconscious. If this happens, someone else can inject the hormone glucagon. If this is not possible it is important to call the emergency services immediately and ask for medical help.

How is Hypoglycemia Diagnosed?

Hypoglycemia is detected by measuring blood sugar levels with a glucose meter. Any blood glucose level below 4.0 mmol/L indicates that the individual has hypoglycemia. Urine tests do not detect hypoglycemia.

If taking a blood test is not possible or would take too much time, it may be better to treat the hypo straight away.

How do I Treat Hypoglycemia?

A mild case of hypoglycemia can be treated through eating or drinking 15-20g of fast acting carbohydrate such as glucose tablets, sweets, sugary fizzy drinks or fruit juice.

Some people with diabetes may also need to take 15-20g of slower acting carbohydrate if the next meal is not due.

A blood test should be taken after 15-20 minutes to check whether blood glucose levels have recovered. Severe hypoglycemia may require an ambulance, for example if loss of consciousness occurs or a seizure persists for more than 5 minutes.

It also causes the typical early warning signs of hypoglycemia, which include sweating, trembling, butterflies in the stomach, tingling, numbness, and rapid pulse.

There are several possible causes of hypoglycemia unawareness.

It can be caused by nerve damage that affects the body’s ability to secrete epinephrine.

People with Type 1 diabetes sometimes develop impaired epinephrine secretion. It can also be the result of very tight blood sugar control, which can dull the body’s ability to feel a drop in blood sugar level.

Sometimes, maintaining slightly higher blood sugar levels for a period of time can improve the ability to detect low blood sugar.

People with hypoglycemia unawareness don’t experience these symptoms. Instead, without warning, they lapse into severe hypoglycemia, becoming confused or disoriented or falling unconscious.

These individuals have lost the epinephrine response to low blood sugar, along with the symptoms epinephrine normally brings on.

Hypoglycemia unawareness can be dangerous to both the person experiencing it and those around him. Because he doesn’t realize that his blood sugar is low, someone with this condition may not know that he is not thinking clearly or that he shouldn’t drive.

If his hypoglycemia goes untreated, he can lose consciousness, and his blood glucose level will continue to fall.

If you have experienced hypoglycemia without warning, be sure to discuss it with your health-care team. They can help you reverse the situation.

Avoiding Hypoglycemia Unawareness

Long-standing Type 1 Diabetes

Reduced awareness of hypoglycemia is common among people who have long-standing insulin-dependent diabetes. Many of those who’ve had diagnosed diabetes for 15 to 20 years report having lost their ability to perceive low blood glucoses and to often failing to treat and prevent severe hypoglycemia.

Severe hypoglycemia is an episode in which the person with diabetes is unable to treat him or herself and needs the assistance of another person. This includes prompting by a relative or friend to drink juice or eat.

Being an older adult and having Type 2 Diabetes

There also have been an increasing number of hypoglycemia unawareness episodes in those with type 2 diabetes; adults older than 65 seem to be most at risk.

Strict avoidance of hypoglycemia for several weeks to months can restore at least partial awareness of warning symptoms. Strategies for avoiding hypoglycemia when you have hypoglycemia unawareness or don’t experience the warning symptoms include:

Aim for a higher blood glucose target

Try to more accurately count carbohydrates

Avoid overcorrection or stacking of insulin doses

Test your blood glucose and adjust your insulin dose more frequently

Consider blood glucose awareness training education programs to help you learn to identify new symptoms and improve recognition

Glucagon for Emergencies

Glucagon is the treatment of choice if someone with diabetes is unconscious or unable to swallow. The length of time a person is unconscious, is more of a concern than how low the blood glucose number is.

Ask your health care provider for a prescription for Glucagon or GlucaGen and for instructions on how to use it. Instruct your family members or friends on how to use this in an emergency and on how to access the emergency response team.

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The medical information is not advice and should not be treated as such.

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